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Insulin Glargine May Reduce Hypoglycaemic Episodes, Improve Glycaemic Control in Children with Type I Diabetes

Insulin glargine combined with NPH insulin may improve glycaemic control while reducing hypoglycaemic episodes in paediatric patients with type 1 diabetes, according to a recent American study.

Previous studies have shown that reducing haemoglobin A1c levels is an important step for the prevention of eye, kidney and nerve complications in patients with type 1 diabetes. However, rigorous treatment can be associated with an increased frequency of hypoglycaemic episodes.

"The occurrence of hypoglycaemia is the major fear of families with children with diabetes and is a major deterrent to improving glycaemic control," writes H. Peter Chase, MD, of the University of Colorado Health Science Center, Denver, United States.

Dr. Chase and colleagues conducted a study to determine whether insulin glargine therapy can improve glycaemic control in children with type 1 diabetes without increasing hypoglycaemic episodes. Insulin glargine, a long-acting insulin analogue, has been previously studied in adult patients with type 1 diabetes, but only one other published report has examined the effects in a paediatric population.

The present study included data for 114 paediatric patients (mean age, 12.2 years, 54 males) treated with insulin glargine as an evening basal 24-hour insulin for at least 9 months. All patients also received NPH insulin in the morning to help cover daytime food intake, and had at least 2 or more A1c values > 8.0% in the previous year.

The researchers detected a significant reduction in the mean weekly frequency of low blood glucose values during the 9 months after starting insulin glargine compared with the previous 9 months (1.3±.1 vs. 2.0±.1 episodes/week, P < .001) In addition, fewer severe hypoglycaemic episodes were reported (9 vs. 22).

Haemoglobin levels during the 9 months on insulin glargine (9.4±.1) were significantly lower than the preceding 9 months (9.6±.1, P=.01), and the insulin dose was significantly lower at 3 months (.92±.03 U/kg, P < .001), 6 months (.94±.03 U/kg, P = .03), and 9 months (.96±.03 U/kg, P = .01) compared with the baseline value (1.02±.03 U/kg).

The researchers suggest that, "insulin glargine should be helpful in reducing nocturnal lows because it does not have the peak of activity as do NPH and Ultralente." In support of this proposal, they found that the majority of improvement in the study was attributable to the reduction of nighttime lows, but recommend that a larger prospective study is needed to confirm this observation.

J Pediatr 2003 Dec;143:6:737-40. "Reduced hypoglycemic episodes and improved glycemic control in children with type 1 diabetes using insulin glargine and neutral protamine hagedorn insulin"

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